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Purchase Order Form Free

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					Koehler Group, Inc.                                                                  ORDER FORM
Koehler Home Décor                                                                                                 DATE:        July 22, 2010
205 SE Spokane St Ste 300
Portland, OR 97202
Phone: 1 866 669 6536            Fax: 1 866 669 6550
E-mail: orders@koehlerhomedecor.com

                                                   BILLING                                           SHIP
                                                                                                      TO




California Non-Taxable Sales - Enter Sales Tax ID#

            QTY                          ITEM #              DESCRIPTION                                       PRICE         LINE TOTAL




                                                                                                               SUBTOTAL $
                                                                                                               SALES TAX $              -
Circle One: Amex, Visa Mastercard Discover # _______________________________Exp:___/____ CCV_____              SHIPPING $
1. Enter sales tax of 8.25% on California taxable sales                                                     ORDER TOTAL $               -
2 Print & fax order toll free to: 1.866.669.6550




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